Panic attacks are extremely scary. They can occur randomly and without any apparent reason or advanced warning. However, before we look at panic, it is important to gain some insight into its function in relation to stress and anxiety.
What is anxiety?
Although anxiety is something we generally prefer not to experience, a certain amount of anxiety is actually very helpful to us. Anxiety can trigger emotions such as fear, worry and apprehension. When there is a tangible reason for these emotions, anxiety’s major function is to help us successfully navigate through those challenges. An example of this could be the anxiety you experience when hiking along a steep slope; fear created by anxiety causes you to be extra cautious and more purposeful in your steps as you navigate your way out of danger. However, for an estimated 1 in 9 individuals in Ireland who suffer with a primary diagnosis of an anxiety disorder (http://www.walkinmyshoes.ie/mental-health/anxiety-disorders/, 2018), anxiety can occur even when there is no real threat, and this can result in significant levels of stress and emotional pain.
When do panic attacks become a panic disorder?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) which is published by the American Psychiatric Association defines a panic attack as a discrete period of intense fear or discomfort, in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes; palpitations, rapid heart rate; sweating; trembling or shaking; shortness of breath; feeling of choking; chest pain or discomfort; feeling dizzy, unsteady lightheaded, or faint; nausea or abdominal distress; derealisation (feelings of unreality); depersonalisation (being detached from oneself); fear of losing control or going crazy; fear of dying; numbness or tingling sensations; chills or hot flushes. (Barlow et al, 1994)
According to Barlow et al, a panic disorder is diagnosed when more panic attacks occur after the initial one and when its reoccurrence is not the result of the physiological effects of a substance (e.g. drugs or alcohol) or the result of a general medical condition (e.g., hyperthyroidism). In addition to this, these recurring panic attacks should not be better accounted for by another mental disorder such as an obsessive-compulsive disorder, posttraumatic stress disorder or a phobia.
What about stress?
It is important to note that when someone experiences panic, is it not necessarily because s/he is also experiencing a lot of stress. Panic is defined as a fearful reaction to what is perceived as a series of frightening symptoms which can occur with or without the individual experiencing even a moderate amount of stress. However, a desirable consequence of dealing with panic would be a reduction in individual levels of stress.
What happens when panic attacks?
As humans, we evolved with a protective mechanism known as the ‘fight or flight response’. This mechanism is triggered when we’re faced with a real and present danger. Our body releases beneficial chemicals such as adrenaline and cortisol to give us the burst of energy and strength needed to stay and fight, or to flee. We experience this surge of chemical release as anxious feelings of being on edge, ensuring that we get ready for action. The body’s response to these chemicals includes the following; rapid breathing to help divert blood to vital organs; diminished peripheral vision so that we can focus on the danger; widened pupils to let in more light; increased heart rate, sending blood to major muscle groups to ready us for action; sweating so that the body does not overheat; and tensed muscles to prepare for a quick departure and to make the body more resilient to attack.
However, our bodies can misinterpret the stress that we experience in our daily lives- such as meeting bills, work deadlines, relationship problems and so on, as the stress associated with real danger. As a result, fight or flight can be activated (sometimes even while we are sleeping) without any obvious reason, resulting in symptoms that can be extremely exaggerated and alarming. A panic attack occurs following an abrupt onset of intense fear or discomfort and peaks within minutes of experiencing the symptoms as outlined by the DSM above. Without a real danger to explain these symptoms, we misinterpret and catastrophise the sensations associated with fight or flight. That false alarm is received by the body, which then responds by releasing even more adrenaline, putting us into a panic cycle as we struggle to understand what just happened as described by Amering et al (1997):
I’m going to have a heart attack
I’m going to die
I’m going crazy
I must be seriously ill
I’m going to faint
everyone will think I’m crazy
I can’t cope with this
I’m going to lose control
However, in spite of those extremely frightening sensations, it is important to understand that panic attacks do not, and cannot cause us any actual harm. Panic attacks occur because we misinterpret and catastrophise the signals of our natural fight or flight response (because they occurred out of the blue), thereby sending a further surge of adrenaline through our bodies. As our first experience of a panic attack is so terrifying, we are subsequently on high alert to prevent another experience like it.
When panic attacks repeatedly
Worrying about the consequences of further panic attacks puts us into a continuous state of underlying anxiety or stress. As a result, constant low levels of adrenaline are produced to keep the body on high alert so that the fight or flight response is more easily triggered. This is known as ’anticipatory anxiety’ (Helbig-Lang et al, 2012). With anticipatory anxiety, we become trapped in the fear of the next panic attack and its imagined consequences. In other words, we panic about panic and, live in fear of the fear.
This fear is maintained by our engagement in safety-seeking behaviours such as: attempting to control the symptoms by fighting or resisting them; distraction techniques; sitting near an exit; only going to places we feel safe; grounding techniques etc. Such behaviours play a huge part in continuing the cycle of fear, perceiving that we avoided a predicted catastrophe because of the safety behaviour/s we adopted. This way, we never learn that had we stayed with the feelings of panic and did nothing to stop them, the disaster we predicted would not have happened and the anxiety would have abated in time.
The fear is also maintained by avoidance as we stop doing things that we believe cause our panic such as: being in large crowds; going to the park, supermarkets; taking trains, exercising; being alone; socialising etc. Avoidance might help reduce levels of fear in the short term, but in the long term, it worsens the problem as the list of the places, people or things to avoid increases and we never learn to cope with panic in any of these situations. Thus, the fear continues. As with the behaviours above, if we don’t experience panic in the places we fear, we never get to test our feared predictions and to understand that situations do not cause panic per se but rather trigger the memory of a previous panic attack in a similar situation, causing a further attack.
How counselling can help
Counselling can help you lose your fear of panic. When you lose your fear, the panic attacks will stop happening. Using Cognitive Behavioural Therapy, your counsellor will help you prove that panic cannot harm you. With cognitive behavioural skills, you will eventually be able to experience the feelings and sensations of panic and put your new understanding to the test.
Call today for an appointment 085 1105742
visit the website https://ambcounselling.ie/
Amering, A., Katschnig, H., Berger, P., Windhaber, J., Baischer, W., Dantendorfer, K., (1997), Embarrassment about the first panic attack predicts agoraphobia in panic disorder patients, Behaviour Research and Therapy, 35(6), 517-521
Barlow, D. H., Brown, T. A., & Craske, M. G. (1994). Definitions of panic attacks and panic disorder in the DSM-IV: Implications for research. Journal of Abnormal Psychology, 103(3), 553-564.
Helbig-Lang, S., Lang, T., Petermann, F., & Hoyer, J. (2012). Anticipatory Anxiety as a Function of Panic Attacks and Panic-Related Self-Efficacy: An Ambulatory Assessment Study in Panic Disorder. Behavioural and Cognitive Psychotherapy, 40(5), 590-604.